DrCloudEHR integrates with the Oregon Health Authority Medicaid Management Information System (MMIS) to provide access to eligibility data for Medicaid recipients.

Requests are submitted once a day to the Oregon Health Authority. Responses may take up to three hours to be returned.

This topic contains the following sections:

Verify Benefits and Eligibility for One or More Patients 

  1. Click the Billing tab.
  2. Click Eligibility & Benefits in the left hand navigation bar.
  3. Select the following:
    • Select the dates the inquiry requests were submitted. This information might be helpful if you want to view the status of requests made over multiple days.
    • Select Medicaid as the Insurance Type.
    • Select one or more Medicaid payers and programs.
    • Select OHA Batch Request as the X12 Partner.
    • If you want to submit a benefits inquiry through the clearinghouse used by the insurance payer, select the name of the EDI connection to use from the X12 Partners menu.



  4. Click Submit Eligibility & Benefit Requests.

Send Eligibility Notifications to Providers

You can configure DrCloudEHR to notify a provider that a patient's insurance coverage has lapsed. Notifications are sent to the provider's Inbox.

To send notifications, you create filters by selecting the insurance payers and programs for the patients to check eligibility for. You can configure the application to send notifications for patients that have appointments the day the request job runs, or for all patients.

  1. Select the criteria to filter on in the Eligibility & Benefit Request(s) And Response(s) page. 



  2. Click Save Filter. 
  3. To send notifications to the provider for patients who have appointments scheduled the day the eligibility request is made, click View Saved Filters.



  4. Select the Run Date Appointments Only checkbox.
    If you don't select the checkbox, notifications are sent for all patients assigned to the selected provider.



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